What if 'the village' is closed?

My daughter was born at the beginning of February. I was just getting into the swing of regular baby groups and making 'mummy' friends when lockdown began. In those first few weeks, I was heavily reliant on midwives, health visitors and my network of family and friends for support and advice. It made me question the impact of social isolation on new mums, particularly on their parental self-efficacy during lockdown, where that support is not possible and is somewhat crudely regarded as 'non-essential'.    

The Children's Commissioner recently released the briefing paper 'Lockdown Babies: children born during the Coronavirus' (May 2020). According to the paper, approximately 1,688 babies are born every day in the UK, which means 113,096 babies will have been born in lockdown so far and there is still little indication of when things will return to normal. It is well-known that the transition to motherhood involves psychological and physical changes that can cause postnatal depression, anxiety and loneliness in normal circumstances. The Children's Commissioner states that in normal circumstances approximately 10 per cent of mothers face perinatal mental illness, and the reduction in regular services will make supporting the mental health of new parents very challenging. The question is what a 'new normal' means in terms of support for new mums and its ramifications on confidence and mental health.   

Isolated and lonely

Mothers having babies during lockdown are dealing with this life-changing event without the support of their families, friends or wider professional network. As part of pandemic control measures, many maternity wards across the UK have only allowed new mums to have a birthing partner present during the final stages of labour and the first few hours of the baby's life. In some circumstances this means women that have been induced can be labouring on their own for days before they are allowed the company of their loved one, making childbirth an isolated and lonely experience.

However, it is not just the labour that is isolated, once the new baby is taken home, the usual fanfare of family and friends coming to meet the new arrival and support the new family cannot take place. Additionally, baby groups are cancelled and children's centres are closed. Health visitors are conducting online consultations and half of them have been redeployed to other roles to support the NHS during the pandemic. Patients are encouraged only to attend essential medical appointments, and the Children's Commissioner reports that many new mums are missing the 6-8 week screening appointment, raising concerns about both parent and baby welfare.

Social isolation for new mothers is particularly concerning as studies have shown that loneliness in new mothers can lead to negative self-evaluations of parenting skills and secret feelings of self-doubt (Lee, 2019). Parents who are feeling lonely are also less likely to ask peers for support and will conceal their low self-efficacy feelings. 

How important is social support?

When thinking of parenting, the anecdote 'it takes a village' comes to mind. Parents' attitudes and behaviours are influenced by a variety of factors including family, peers and the wider social environment. Several studies have identified that first-time mothers are particularly affected by low parental self-efficacy, and social support has a significant impact on mums during the initial post-partum stage (Shorey et al., 2013). Studies focusing on improving parental confidence suggest that social influences can help, through methods such as peer support and encouragement. Parental education programmes focussing on problem-solving and dealing with parenting challenges have also been proven to boost self-efficacy. The impact of community support from health professionals cannot be underestimated and the Children's Commissioner has urged the government to put the issue at the heart of its pandemic policy-making.

Can online support replace community social support? 

During lockdown people have increasingly turned to online platforms that allow the participants to video call multiple people at the same time. These platforms are not only being used by family and friends but also by professionals setting up online baby groups too. Whilst these advances in technology mean people are able stay in touch with each other, from personal experience, it cannot compensate for that physical extra pair of hands that allow you to finish the rare cup of tea while it's still hot! Equally midwives and health visitors are often required to offer hands-on support when it comes to support new mums with aspects of baby care, which will be difficult to achieve online.  

However, online support groups are widely used and can be effective in boosting parental confidence. Studies into parental confidence have found that parents with low self-efficacy are much more likely to seek support from peers online. Boyd and colleagues (2019) conducted a comparison study of online and in-group interventions on new parents with post-natal depression symptoms. The study found that engagement in the online group was much higher and it also resulted in increased self-efficacy. Whilst this research is positive in terms of the outcomes for new parents using online networks for support, it was conducted in a time when community social support was simultaneously available.    

What is being done to support new mums? 

Many prospective parents choose to join the National Childbirth Trust (NCT) and attend groups not only for lessons in parenting but also for the social aspect of meeting other new parents. The NCT groups are now offering parenting courses online via video-link instead of in person. To support the social aspect, they have also offered online forums, set up to connect parents to other in their local area. 

Many health services are being offered via telephone or online appointment including video calls. The health visitor in my local area has been offering online clinics via zoom in lieu of cancelled sessions. Some instructors of parenting courses are also adapting and delivering condensed sessions via online platforms. These are not without technical issues and many of the video conferencing platforms only allow one person to speak at a time, meaning participants in one parenting course I recently accessed online were reluctant to contribute.   

The children's commissioner has voiced concerns about how willing a new mum having issues will be to divulge her worries over a video call or telephone conversation with a health professional, especially if they haven't met in person before. Whilst the health services are continuing to visit patients and children that are considered vulnerable or known to social services, there are a large number of parents who will only have access to limited support. 

Like all aspects of life, it is difficult to speculate about the impact lockdown will have on the mental health of new mums as these are unprecedented times. What is clear is the impact of social support on self-efficacy cannot be underestimated. Health professionals need to maintain contact with all new mums, not just the ones considered vulnerable. 

- Georgina Ferguson recently completed her masters research project on the effects of different types of social support on the self-efficacy of first-time mums.

References

Boyd, R. C., Price, J., Mogul, M., Yates, T., & Guevara, J. P. (2019). Pilot RCT of a social media parenting intervention for postpartum mothers with depression symptoms. Journal of Reproductive & Infant Psychology, 37(3), 290–301. 

Lee, K., Vasileiou, K., & Barnett, J. (2019). 'Lonely within the mother': An exploratory study of first-time mothers' experiences of loneliness. Journal of Health Psychology, 24(10), 1334–1344.        

Shorey, S., Chan, S. W.-C., He, H.-G., & Chong, Y. S. (2013). Maternal parental self-efficacy in newborn care and social support needs in Singapore: A correlational study. Journal of Clinical Nursing, 23(15–16), 2272–2283.